Open Access Research article

Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study

Wolter Paans12*, Walter Sermeus2, Roos MB Nieweg1, Wim P Krijnen1 and Cees P van der Schans1

Author Affiliations

1 Research and Innovation Group in Health Care and Nursing, Hanze University of Applied Sciences, post-box 3109, 9701 DC, Groningen, the Netherlands

2 School of Public Health, Faculty of Medicine, Centre for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium

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BMC Nursing 2012, 11:11  doi:10.1186/1472-6955-11-11

Published: 1 August 2012



This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses.

Knowledge sources can support nurses in deriving diagnoses. A nurse’s disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses.


A randomised factorial design was used in 2008–2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1) a knowledge inventory, (2) the California Critical Thinking Disposition Inventory, and (3) the Health Science Reasoning Test. Nurses (n = 249) were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor.


The use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse’s age and the reasoning skills of `deduction’ and `analysis’.


Improving nurses’ dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.

Clinical practice; Critical reasoning; Knowledge; Nursing diagnoses; RCT